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Fixed Prosthodontics II > L1: Treatment planning & Biomechanics of FPD > Flashcards

L1: Treatment planning & Biomechanics of FPD Flashcards

1
Q

FPD may also be referred to as a:

A

bridge

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2
Q

A dental prosthesis definitively attached to remaining teeth or to dental implants, which replaces one or more missing teeth:

A

FPD (bridge)

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3
Q

Label the following image:

A

A- retainer
B- pontic
C- connector
D- retainer
E- abutment tooth (prepped)
F- connector
G- abutment tooth (prepped)
H- abutment
I- abutment
J- edentulous ridge

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4
Q

Natural tooth or implant serving as attachment for FPD:

A

Abutment

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5
Q

Extra-coronal restoration cemented to abutment:

A

Retainer

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6
Q

Artificial tooth suspended from abutments:

A

Pontic

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7
Q

Rigid (or non-rigid) connecting Pontic and retainers:

A

Connector

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8
Q

The site of the alveolar bone and its covering soft tissues that remains after tooth loss:

A

Edentulous ridge

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9
Q

What is a goal for every orthodontist?

A

Intact dentition and a state of dynamic equilibrium

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10
Q

With an intact dentition and a state of dynamic equilibrium there are _____ keeping the teeth in their locations

A

equal pressures

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11
Q

In intact dentition and state of dynamic equilibrium, the teeth stay in position based on:

A

hitting opposing teeth

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12
Q

In this image we see loss of tooth #19, what are the results of this?

A

14 extrusion

#20 drifting distally
Space created between #20 & #21
#18 mesial tilt

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13
Q

In this image we see loss of tooth #19, this results in:

#14 extrusion
#20 drifting distally
Space created between #20 & #21
#18 mesial tilt

These consequences are due to:

A

Improper occlusal pressure and lack of interocclusal space

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14
Q

What type of interferences may result from this image?

A

Excursive movement interferences and possible loss of full range of movement

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15
Q

Consequences of unrestored tooth loss include:

A
  1. tooth movements
  2. no tooth omvement
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16
Q

The tooth movement resulting from unrestored tooth loss may include:

A
  1. over-eruption
  2. tilting & drifitng
  3. disruption of occlusion
  4. pain & TMJ dysfunction
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17
Q

T/F: For some reason some teeth never move after loss of proximal or opposing contacts

A

True- freaks of nature

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18
Q

What should be done prior to bridge placement in regards to occlusion?

A

Re-establishing harmonious occlusion

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19
Q

Give an example of re-establishing harmonious occlusion prior to bridge placement:

A

Placing a crown on a super-erupted tooth that opposes the bridge location

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20
Q

______ are produced when an FPD is made to the over-erupted dentition

A

Occlusal interferences

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21
Q

T/F: There will not be consequences when an FPD is made to the over-erupted dentition

A

False- occlusal interferences will likely occur

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22
Q

When an opposing tooth is restored to a corrected occlusal plane this prevents:

A

interferences

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23
Q

Restoring an opposing tooth to a corrected occlusal plane to prevent interferences may require: (7)

A
  1. odontoplasty
  2. restoration
  3. crown
  4. RCT
  5. crown lengthening
  6. intrusion
  7. extraction
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24
Q

When the teeth have been missing for a long time, extreme ____ of the _____ can occur which requires more extreme treatment planning, and for the general dentist, likely a referral to a prosthodontist for treatment

A

closure; inter-occlusal distance

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25
Q

What can be seen in this image?

A

Extreme closure of inter-occlusal distance

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26
Q

What are some prosthetic treatment options for a partially edentulous patient?

A
  1. RPD
  2. Tooth supported FPD
  3. Implant supported FPD
  4. Nothing
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27
Q

A tooth supported FPD is a treatment option for partially edentulous patients. What are some design types?

A
  1. conventional
  2. resin-bonded
  3. cantilever
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28
Q

T/F: It is NEVER an option to do nothing. This is considered negligence.

A

False- ALWAYS an option to do nothing!!

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29
Q

List indications for a removable partial denture:

A
  1. long edentulous spans
  2. no distal abutment
  3. multiple edentulous spaces
  4. abnormal abutments
  5. periodontally weakened primary abutments
  6. severe loss of tissue/bone is residual ridge
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30
Q

Abnormal abutments is an indication that an RPD is a better option than an FPD. Describe some abnormal abutments:

A

-tipped
-divergent
-few

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31
Q

Why would an RPD be indicated in this case?

A

No distal abutments

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32
Q

What information do you need to know to determine the prognosis of a fixed bridge for treatment planning?

A
  1. X-rays
  2. perio charting
  3. decay prevention
  4. home care
  5. reasons for previous tooth loss
  6. clencher/grinder?
  7. finances
  8. condition of existing crowns
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33
Q

Indications for an FPD:

A
  1. to replace FUNCTION of missing teeth
  2. to STABILIZE OCCLUSION and keep teeth from drifting & extruding
  3. to create ESTHETICS & PHONETICS
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34
Q

In order to do an FPD we need properly distributed _____

A

abutments

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35
Q

List the requirements satisfying “properly distributed abutments” for an FPD

A
  1. abutments on both ends of edentulous space
  2. span length falls within structural limits
  3. straight alignment of restoration (slight variations)
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36
Q

Describe what contributes to abutment strength:

A
  1. abutments need to be restorable
  2. periodontally sound & stable
  3. no questionable pathology (PARL, non-vital)
  4. occlusal harmony
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37
Q

Contraindications for FPD include:

A
  1. excessive loss of alveolar ridge
  2. abutments not restorable
  3. abutments are periodontally compromised
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38
Q

Excessive loss of the alveolar ridge is a contraindication for an FPD, this is because:

A
  1. difficulty cleaning
  2. difficulty in esthetics
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39
Q

T/F: it is possible to correct excessive loss of alveolar ridge to some degree with bone graft/augmentation with periodontal surgery

A

True

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40
Q

In what situations would abutments for an FPD be considered “non-restorable” and therefore be contraindicated:

A
  1. short clinical crown
  2. heavily restored already
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41
Q

Abutments for an FPD are considered “periodontally compromised” and therefore a contraindication if:

A
  1. loss of bone
  2. bad crown to root ratio
  3. long span between abutments
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42
Q

With virgin or minimally restored abutments we prefer to pursue:

A

implant options

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43
Q

List some characteristics of an IDEAL FPD:

A
  1. Periodontally sound abutments
  2. Tissue follows contour of Pontic & abutment
  3. Span is within structural parameters
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44
Q

What are the criteria categories we use for abutment evaluation?

(Can you vs. Should you)

A
  1. restorative assessment
  2. endodontic assessment
  3. periodontal assessment
  4. abutment positional assessment
  5. radiographic assessment
45
Q

Describe what is considered in regards to the RESTORATIVE ASSESSMENT for abutment evaluation:

A
  1. Coronal tooth structure
  2. Previous restorative treatment
46
Q

Describe what is considered in regards to the ENDODONTIC ASSESSMENT for abutment evaluation:

A
  1. Pulp status
  2. Pathology
47
Q

Describe what is considered in regards to the PERIODONTAL ASSESSMENT for abutment evaluation:

A
  1. crown to root ratio
  2. root configurations
  3. periodontal surface area
48
Q

Describe what is considered in regards to the ABUTMENT POSITIONAL ASSESSMENT for abutment evaluation:

A
  1. tilted?
  2. inclined?
  3. orthodontic position?
  4. path of insertion evaluation
49
Q

Describe what is considered in regards to the RADIOGRAPHIC ASSESSMENT for abutment evaluation:

A

Anomalies

50
Q

How do evaluate the abutment?

A
  1. clinical examination
  2. radio-graphic examination
  3. diagnostic casts
51
Q

For the radiographic examination of an abutment, it is recommended to do ____ for a patient that is considered complex

A

Full mouth series

52
Q

List some questions to be considered when evaluating the abutments:

A
  1. adequate retention & resistance form possible?
  2. adequate wall length?
  3. is the tooth restorable as is or is decay present?
  4. if decay is present, can restorability be gained with foundation or modification of the prep?
  5. what is the apical extent of caries or restoration?
53
Q

Tooth is asymptomatic with sound tooth structure remaining- when evaluating this tooth for abutment consideration, we would classify this as:

A

vital tooth (good candidate)

54
Q

In regards to pulpal health, what would deem a tooth to be questionable as an abutment?

A

Deep excavation, near pulp exposure, pinpoint exposure, inadequate RCT or post

55
Q

In order to confirm the health of abutments we need current PA radiographs of less than:

A

6 months old (he prefers within weeks)

56
Q

T/F: If we are planning on a long-lasting FPD, then any questions about the foundation/abutment health needs to be addressed prior to making a definitive FPD

A

True

57
Q

______ health is a prerequisite for any fixed prosthodontics restorations

A

periodontal

58
Q

Describe “periodontal health prerequisites” in regard to abutment evaluation:

A
  1. need a zone of attached tissue
  2. no mobility
  3. adequate patient home care
59
Q

In addition to the following periodontal health prerequisites- need a zone of attached tissue, no mobility, adequate patient home care what else is it beneficial to evaluate for abutment evaluation:

A
  1. crown to root ratio
  2. root shape & configuration
  3. PDL area
60
Q

Placing a finger on one side of the tooth and tapping firmly on the other side of the tooth with a mirror.

What test is this- what does it tell you?

A

Fremitous test; tells you if the tooth is completely solid in the socket

61
Q

A solid sounding fremitous test=

A

tooth completely solid in socket

62
Q

The ratio of the portion of the tooth occlusal to the alveolar crest vs. the portion of the tooth embedded in the root:

A

crown to root ratio

63
Q

What is an optimum crown to root ratio for an abutment tooth?

A

C:R 2:3

64
Q

What is the minimum crown to root ratio for an abutment tooth?

A

C:R 1:1

(For fixed restorations)

65
Q

Horizontal bone loss dramatically reduces:

A

supported root surface area

66
Q

_______ dramatically reduces supported root surface area

A

horizontal bone loss

67
Q

The _____ diminishes the actual area of support more than expected from the height of the bone

A

conical root shape

68
Q

According to this image, the center of rotation (____) moves ____ and the over arm (___) _____, greatly magnifying the forces on the supporting structures

A

R; apically

L; increases

69
Q

The center of rotation (R) moves apically and the lever arm (L) increases, greatly magnifying the forces on the supporting the structures.

This can increase _____, further ____ and ultimately _____

A

Tooth mobility; bone loss; failure of FPD

70
Q

What are the exceptions to the crown to root ratio guidelines?

A

If opposing occlusal forces are diminished such as:

-artificial teeth (full denture, RPD)
-periodontal compromised opposing teeth

71
Q

What is a better abutment tooth? A multi-rooted tooth or a single-rooted conical tooth?

A

multi-rooted tooth

72
Q

What is a better abutment tooth? A multi-rooted tooth with separated roots or a multi-rooted tooth with fused roots?

A

multi-rooted with separated roots

73
Q

What is a better abutment tooth? A tooth with long roots or a tooth with short roots?

A

Long roots

74
Q

What is a better abutment tooth? Single rooted tooth with a perfect taper or single rooted tooth with irregular configurations/curvatures?

A

single rooted tooth with irregular configurations/curvatures

75
Q

For an abutment tooth, a tooth that is broader ____ or ____ is preferred over a ____ tooth

A

FL or MD; round

76
Q

The root surface area (embedded in bone) of the abutment teeth should be equal or surpass that of the teeth being replaced with pontics:

A

Ante’s law

77
Q

When using Ante’s law, a ____ number is considered favorable

A

positive

78
Q

Use Ante’s law to determine if the following FPD would be favorable:

A

180 + 426 = 606

606- (207+431)= -32

UNFAVORABLE

79
Q

T/F: Even if Ante’s law results in an unfavorable (negative) number, you may still be able to accomplish an FPD with very optimal occlusion

A

True

80
Q

Ante’s law describes:

A

root surface

81
Q

A general principle is that any FPD replacing _______ has a guarded prognosis

A

more than two posterior teeth

82
Q

Even though the general principles is that any FPD replacing more than two posterior teeth has a guarded prognosis the ____ arch has longer crowns and less tooth inclinations and can therefore occasionally be acceptable

A

maxillary arch

83
Q

What is NOT considered in Ante’s law and therefore suggests there are shortcomings with Ante’s law?

A

Occlusal scheme

84
Q

Failures in FPDs are more due biomechanics factors like _______, than due to over stressing of periodontal ligaments.

(shortcomings of ante’s law)

A

-caries
-gingival inflammation
-poor framework design
-poor occlusion
-material failure

85
Q

Failures in FPDs are more due to ______ than due to ____

A

biomechanical factors; over stressing of PDL

86
Q

T/F: Studies have revealed successful FPD’s supported by periodontally weakened teeth

A

True

87
Q

Conclusion:” _____ is the key to success. Even the worst cases with doubtful prognosis had good success rates when ____ was right/”

A

Occlusion; occlusion

88
Q

In regards to path of insertion of the bridge, ____ walls of abutment teeth must be aligned without undercuts or interferences

A

axial walls

89
Q

Why can a tipped tooth be very difficult to prepare effectively in regards to path of insertion?

A
  1. exposure of mesial pulp horn
  2. unfavorable occlusal forces if tilt is significant
  3. possible orthodontic uprighting prior to prep
90
Q

Using diagnostic casts, you can evaluate:

A
  1. edentulous spaces and span length
  2. curvature of the arch
  3. MD drifting & rotations
  4. FL displacement of abutments
  5. inclination
  6. occlusion & interocclusal space
  7. path of insertion
91
Q

When teeth are not perfectly aligned (most commonly), a _____ can be used to identify the path of insertion and to help you create the appropriate planes in tooth preparation to create a path of insertion

A

surveryor

92
Q

What anatomical feature should be evaluated on the radiograph?

A

maxillary sinus (is there a lack of bone support due to sinus pneumatization)

93
Q

T/F: Full mouth series of radiographs within 12 months is nearly mandatory for any bridgework

A

False- FMX within 6 months is mandatory

94
Q

For a partially edentulous patient, additional options for FPD include:

A
  1. resin-bonded fixed partial prosthesis
  2. cantilever fixed partial prosthesis
  3. implant supported FPD
95
Q

A resin-bonded fixed partial prosthesis may also be known as:

A

Marilyn bridge

96
Q

A Marilyn bridge (resin-bonded fixed partial prosthesis) has what type of prep?

A

conservative enamel only prep

97
Q

A Marilyn bridge (resin-bonded fixed partial prosthesis) is used for ______ with _____

A

Single missing tooth with slight to moderate tissue resorption in missing tooth area

98
Q

What are the requirements for the neighboring teeth with a Marilyn bridge (resin-bonded fixed partial prosthesis)?

A

Only areas of light occlusal stress & good alignment

99
Q

A Marilyn bridge (resin-bonded fixed partial prosthesis) is not indicated fro:

A

deep vertical overlaps (deep bite)

100
Q

An excellent option in younger patients where age contraindicates implant or bridge:

A

Marilyn bridge (resin-bonded fixed partial prosthesis)

101
Q

Most often used to repulse missing maxillary lateral incisors:

A

Marilyn bridge (resin-bonded fixed partial prosthesis)

102
Q

What would be an ideal option for a young patient missing their maxillary lateral incisors?

A

Marilyn bridge (resin-bonded fixed partial prosthesis)

103
Q

A fixed partial denture that has an abutment(s) at one end with the pontic remaining unconnected on the other end:

A

Cantilever fixed partial prosthesis

104
Q

What type prosthesis is seen in the following image?

A

Cantilever fixed partial prosthesis

105
Q

What are indications for an implant supported FPD in a partially edentulous patient?

A
  1. implant abutments are soundly integrated
  2. implant parallelism
  3. availability of bone to support implant
  4. patient demonstrates adequate home care
106
Q

Why are implant supported FPDs controversial?

A
  1. patient cannot remove
  2. expensive
  3. hygiene is a challenge
  4. needs replacement every ten years
107
Q

What anatomy needs to be considered when placing implants?

A
  1. maxillary sinus
  2. IAN
  3. Anterior angulation of bone
108
Q
A

Fixed Prosthodontics II (15 decks)

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